Warning: Stress about work or relationships can actually break your heart

Emory University professor of cardiovascular research Viola Vaccarino and her colleagues assessed whether a participant developed myocardial ischemia - reduced blood flow to the heart muscles that can trigger events such as heart attacks and strokes - when they were emotionally or physically stressed. After tracking them for four to nine years, Vaccarino and her team discovered that participants who experienced myocardial ischemia after being mentally stressed were more likely to suffer a heart attack or to die of cardiovascular disease in the years that followed.

“Our findings are significant because they highlight the importance of emotional factors on the clinical course of patients with heart disease, providing compelling evidence to include stress and mental health indicators in the risk assessment of these patients,” Vaccarino says.

Medical director of the Irish Heart Foundation Dr Angie Brown says stress can certainly take its toll on our hearts, raising the risk of heart attacks and even rare conditions such as Takotsubo cardiomyopathy or broken heart syndrome. “Anything which helps you to relax will help to lower your stress levels and help to balance your blood pressure,” she says. “Controlling stress will have a lasting effect on your health and limit your chances of heart attack in the future.”

But how to manage our stress levels? Dr Sabrina Brennan, a neuroscientist at Trinity College Dublin, says it is important not to get anxious about experiencing small amounts of stress. “Stress is not always a bad thing and becomes problematic only when we don’t manage it well,” she says. “Chronic long-term stress can have effects on the brain and the heart, so it is important to learn there are ways you can control how you respond to stress.”

Even healthy people can be affected

Emotional stress causes acute and chronic inflammation, increases in blood pressure and heart rate, constriction blood vessels and long-term metabolic effects such as insulin resistance, obesity and diabetes all of which are bad for the heart.

Stress also causes mental disturbances like depression and post-traumatic stress disorder that have also been related to cardiovascular disease risk. It’s not just people already who are at risk of its effects. “People with underlying heart disease tend to show larger harmful effects of stress than those without heart disease,” says Vaccarino. But people without cardiovascular disease can also be affected. Research has shown that even perceived stress – believing we are stressed - is associated with increased cardiovascular events.

Some personality types are more affected by stress

Not everybody who experiences emotional stress has the same cardiovascular response - some people are naturally more resilient to stress than others. If you are an ‘A Type’ personality – traits include impatience, a competitive nature, getting upset easily – you are likely the kind of person who gets easily anxious and frazzled and the chances are you are more likely to experience a rise in risk factors such as high blood pressure.

“Everyone manages stress differently, and some people find stress is helpful when preparing for an exam or a presentation,” says Dr Brown. “Goal-oriented stress can have a finite and useful purpose but chronic stress or stress from situations that are out of our control - like the pandemic - are more likely to be harmful. We need to understand our stressors and try to manage them.”

Stress releases hormones that affect the heart

Hormones released when we are stressed undoubtedly play a role. Acute stress that occurs when witnessing an accident, for example, activates the body’s ‘fight or flight’ response. “Stress can release hormones like adrenaline and cortisol. These can increase the heart rate and blood pressure, which puts increased demands on the heart and therefore increases the risk of cardiac issues,” says Dr Brown.

This surge of hormones occurs when blood pressure and heart rate rise, leading to increased demands on the heart that are similar to physical stresses such as very intense exercise. Stress hormones also increase inflammation and oxidative stress in the body, both of which can raise the risk of cardiovascular disease.

Emotional stress produces brain changes that affect the heart

For a study published in the European Heart Journal [exa.mn/Heart-Stress-Noise], Michael Osborne, a cardiologist at Massachusetts General Hospital, looked at how the body responds to chronic psychological stress in 498 healthy people. He found that repeated stressful events – in this case, exposure to traffic noise – led to prolonged activation of stress responses, such as raised hormones and blood pressure, and to changes in the brain.

In cases of extreme emotional stress, the brain is known to trigger the limbic system, the part of the brain involved in our behavioural and emotional responses, and can cause rare cardiac conditions such as broken heart syndrome or certain types of less common heart attacks called spontaneous coronary artery dissection.

Get at least seven hours of sleep a night

Several studies have linked poor sleep patterns with higher stress levels and stress-related mental health problems. Too little sleep has also been shown to affect anxiety, emotions, and mood regulation. “Sleep deprivation increases stress hormones. Poor sleep is associated with higher blood pressure – as normally the blood pressure falls overnight when sleeping,” says Dr Brown.

“This ‘non dipping’ pattern is another risk factor for heart disease although poor sleep may also trigger inflammation a further risk for developing atherosclerosis.”

She adds that chronic lack of sleep is correlated with obesity and may worsen glucose metabolism.

Getting enough sleep provides an opportunity for the body to restore and reset. Levels of stress hormones such as cortisol fall when we are sleeping, and studies have shown that erratic sleeping, as with shift workers, holds increased cardiovascular risk and in some people can cause irregular heart rhythm (atrial fibrillation). Getting at least seven hours of sleep a night is key.

Exercise for 150 minutes a week to reduce stress

Dr Brown says that physical activity is good for your physical and mental health. “Doing regular exercise helps to lower your heart rate, and blood pressure helps maintain a healthy weight and may improve your good cholesterol, or HDL,” she says. “It also combats stress.”

According to the European Society of Cardiology, we should aim for 150-300 minutes of moderate-intensity activity – fast walking, jogging, moderate cycling – or 75-150 minutes per week of vigorous aerobic exercise such as hard running or swimming each week.

Try tai chi, yoga and meditation

Mind-body relaxation techniques are hugely effective at reducing damaging stress levels. They have been shown to help to clear the mind and, in turn, reduce levels of catecholamines, hormones in the body such as adrenaline that are released when we are stressed.

Douglas Bremner, a professor of psychiatry in the Emory University Clinical Neuroscience Research Unit, says his studies with Vaccarino have shown that mindfulness-based stress reduction techniques have a profound effect on reducing even severe levels of stress.

“They enhance function in brain areas such as the prefrontal cortex that controls our stress response,” he says. “They reduce symptoms of post-traumatic stress and also peripheral inflammation, all of which will be beneficial in reducing the risk of stress-related cardiovascular events.”

Have a laugh every day

Taking life too seriously is one way to ensure stress levels rise. But a daily dose of laughter can offset that risk by ameliorating symptoms of depression, stress and insomnia. According to a study of 20,934 people [exa.mn/Heart-Laughter], published in the Journal of Epidemiology, laughter can improve vascular health in the short term by immediately improving arterial stiffness and blood vessel function, but also in the long term.

Researchers found that among people who laughed most days the prevalence of heart disease was lower than among those who said they rarely giggled. “Those who reported having been diagnosed with stroke or heart disease were found not to laugh as often as those who did not have a history of stroke or heart disease,” the team wrote.

Go for a 50-minute ‘green’ walk every week

Walking is known to be good for heart health and stress relief, but the effects of walking in green, natural surroundings such as a park or woods, can have a profound effect on reducing heart-damaging stress levels.

Researchers at the University of Minnesota, reporting in the journal Environmental Research [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877549/] found that while walking in a green or suburban environment reduced stress and promoted reductions in blood pressure, a weekly 50-minute ‘nature walk’ at a moderate intensity elicited greater heart rate responses, a sign that stress had diminished.

Drink a mug of cocoa

When stress levels are rising, an antidote for your heart could be a mug of cocoa. Researchers at the University of Birmingham reporting in the journal Nutrients [exa.mn/Heart-Cocoa] found that blood vessels functioned better during periods of emotional stress when people were given a drink of flavanol-rich cocoa. Found naturally in fruit and vegetables including the cocoa bean, flavanols are chemicals with proven cardiovascular benefits.

According to Dr Catarina Rendeiro, lead author from the School of Sport, Exercise and Rehabilitation Sciences, drinking cocoa reduced temporary impairments in blood vessel function and improved blood flow during mentally stressful episodes.

How to manage emotional stress

• Stay active - aim to be active for at least 30 minutes five days per week. Walk briskly, cycle, jog, swim or enjoy any favourite activity for 30 minutes or more.
• Learn to accept what you cannot change.
• Get enough sleep and rest to recharge your batteries.
• Stop arguing with people. Life does not have to be a constant battleground.
• Manage your time - learn to prioritise, make lists, and praise yourself for getting through the various tasks.
• Plan ahead and learn to say ‘no.’ · Take up a hobby. Work or family commitments do not have to take up all of your time.
• Eat a variety of foods with lots of fruit and vegetables every day and cut down on fat.
• Learn to relax – meditate, listen to music, read or do yoga.
• Talk to your doctor who may advise you to see a specialist or call the Irish Heart Foundation’s Nurse Support Line on 01 6685001.